PMT17-04290 City of Menifee Permit No.: PMT17-04290
29714 HAUN RD.
't;�jCCQL_/-> MENIFEE,CA 92586 Type: Residential Plumbing
MENIFEE Date Issued: 12/04/2017
PERMIT
Site Address: 32335 LINDENBERGER RD,MENIFEE, Parcel Number: 372-140-015
CA 92584 Construction Cost: $5,000.00
Existing Use: Proposed Use:
Description of LEACH LINE REPLACEMENT 3 CHAMBERS 60'FEET LONG
Work: RIVERSIDE COUNTY APPROVAL 11/29/07
Owner Contractor
GLEN SORUM LANIK ENTERPRISES INC
32335 LINDENBERGER RD P 0 BOX 891416
TEMECULA,CA 92589
Applicant Phone:9516767114
LANIK ENTERPRISES INC License Number.458947
P 0 BOX 891416
TEMECULA,CA 92589
Fee Description Qtv Amount($1
Sewer 1 150.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
SMIP RESIDENTIAL 1 1.00
General Plan Maintenance Fee-Plumbing 1 7.50
$186.50
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carded on thereunder when in violation of the Building Code or of any other
ordinance of City of Marilee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or Improves thereon,and who contracts for the projects
With a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjurythat I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from Iicensure.under the Contractor's State License Law for
Professions Code and my license is In full force and effect. the fallowing reason:
License Class 0&8 C�License No.
By my signature below I acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
4�11improvements covered by this permit.)cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder If It has not been constructed in its entirety by
❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when
compensation,Issued by the Director of Industrial Relations as provided for this application Is submitted or at the following website:
by Section 37DO of the Labor Code,for the performance of work for which �yyy�y,leeinfo.ca.eov/calaw.html.
this permit is issued.
Policy q Date
❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which pray my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carder and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information I have provided is correct.1 agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
�J building construction.I authorize representatives of this city or county to
Policyri �� ��'�ff l? entert eab eidentffied ropertyf r inspection purposes.
(This section need not to be completed is the permit Is for one-hundred r Z —/
dollars($100)or less Date
PROPERTY OWNPZR AUTHORIZED AGENT
o 1 certify that in the performance of the work for which this permit Is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE ft
workers compensation laws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall fo I( ith co ly with tnhw provis')ns. Will the applicant or future building occupant handle hazardous material or a
Applicant r Date �Z"-]'— mixture containing a hazardous material equal to or greater that the
amounts specified on the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECUR ORKER'S COMPENSATION COVERAGE IS o Yes pNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes Wvo
I hereby affirm that under the penalty of perjury there is a construction WIII the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) 0 Yes
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjurythat I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes �IPo , _
Business and Professions Code).Any city or county that requires a permit to Date- 2 4 /�
construct,alter,improve,demolish or repair any structure,prior to its pR RTY OWNER AUTHORIZED AGEM
Issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP)
Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint In a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPAN Renovation Program Visit:
compensation,will do( )all of or( )portion of the Work,and the structure Is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or Improves the
property provided that the Improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or Improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION
g
'Menifee
DATE: it � PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL ® RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW 6 PLU�MBING O RE-ROOF NUMBER OF SQUARES
DESCRIPTION OF WORK L.E-�/-1.-� vot
PROJECTADDRESS ZIP
ASSESSOR'S PARCEL NUMBER I/`,-lib OT TRACT
OWNERNAME V/ rv-%
ADDRESS LA ndey) b/ce v-
PHONE �� �� r /�'i�j EMAIL
APPLICANT NAME,, C
ADDRESS V 1 (o :kmctcu A 0/
PHONE EMAIL 1 . IGY�
CONTRACTOR'S NAME v , S OWNER BUILDER? O YES ®NO
BUSINESS NAME \I M1- �P/VJJ, � yl
�J
ADDRESS I I,VJ 2S8
PHONE EMAIL r I o I Cl (J M
CONTRACTOR'SSTAAT�T++E LIC NUMBER 4�gjej LAJ LICENSE CLASSIFICATION Ig
VALUATION$ �,/ee>OOI D SQ FT L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFF USE ONLY _
DEPARTMENT DISTRIBUTION CRY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY:
PERMIT FEE SMIP GREEN
PLAN CHECK FEE INVOICETOTAL
OWNER BUILDER VERIFIED _:.YES 0 NO DRIVERS LICENSE## NOTARIZED LETTER O YES O NO
City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777
www.cityofmenifee.us
DEPARTMENT OF ENVIRONMENTAL HEALI'i-lf
CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SYSTEM
Land Use&Water Resources
Western Riverside County Eastern Riverside County
3880 Lemon Street•Suite 200•Riverside•CA•92502 47-950 Arabia Street•Suite A•Indic•CA•92201
Phone:(951)955-8980•Fax: (951)955-8988 Phone: (760)863-7570•Fax:(760)863-7013
Property Infonnati' n: APN: 37 2,-�(1U 6 Date of Inspection: (I -'Z.R - 17
1. Owner: 6 e - k ddress: 3Z Gndenbgr&.2¢- city: ;.
e✓� So,r,,�,,r
FAILUR TO PROVIDE ALL REQUIRED INFORMATION SHALL PREVENT OWNER FROM OBTAINING
- ENVIRONMENTAL HEALTH APPROVAL
2. Show design and location on a scale of 1:20 or 1:40 of the sewage disposal system and 100%expansion area in relation to
attached dwellings,structures,wells, rocks,watercourses,etc.
3. a. I examined existing subsurface sewage disposal system at the abo/nvv���e� location on I-2 and determined that
the tank capacity is Q Q C7 gallons and that there is sq.ft.of leach line bottom area. There are
3 bedrooms in the dwelling and there are fixture units. ta,j yt C-kR 5 Ca e_jC
b. There are 2 leach line(s),each -7 -V_ ft. long. Rock ❑ Plastic Chamber
d. There are Seepage pit(s),each in.diameter,and ft.TD. ft. 61
e. The leach bed is ft by It.,total sq.ft.of leached area.
4. a. Construction of septic tank(Please check one of the following):
Itconcrete }"' A Fiberglass ❑Steel ❑ Other:
b. Internal dimensions of septic: Length $ ft. Width S ft. Depth t 2 ft.
c. Condition of tank(please check yes or no for each question): Inlet Tee present? &Yes ❑ No
Tank Structure deteriorated? ❑Yes hP�N,Io Outlet Tee present? )@ Yes ❑No
Effluent Filter Present? ❑Yes)Ii No Two compartments? 4 Yes ❑No
d. Condition of D-Box: Level? Yes ❑ No Replaced? ❑Yes�i1Jo Septic Effluent? ❑Yes No
5. a. While pumping the tank,did effluent flow back into tank from absorption system? ❑Yes PNo
b. Prior to pumping,was the liquid level in the tank above the outlet tee? ❑Yes Wo
c. Was the area around the lids oxidized? ❑Yes NkNo
d. Is design of system gravity feed? Yes ❑No
e. Were well(s)observed on this or a jacent property? '6'es ❑No
If yes,indicate distance of well from: Septic tank ( ' ft Leach lines to Seepage Pits _ ft.
I. Distance from springs,lakes,and natural water courses(check all that apply)
❑ Septic Tank R. ❑ Leach lines ft. ❑Seepage Pits ft.
g. Is sewer is within 200 ft.of system and abuts property line? ❑Yes EP'No
Additional Comments:
h. How long has dwelling been vacant?(f applicable) months weeks ITNIA
6. a. ❑ It is my opinion that the system appears to be in good working order and can be expected to function property with
proper maintenance. No repairs are necessary at this time.
b. It is my opinion that the system is not in/good working ord.•err a�and will not function properly witho t the following
n
repairs: Ip� LLJ-03 ?31 r/I!y4 t'w It. CC
�001d
I certify under pen (Y of peduty that foregor g is true a d correct. r ,,
Signature: �_ ly'?- yi �j,�1 IT Print Name:
Contractor License No.: ! -N-7 Expiration Date: . 30-j',
Pumper Co.: Lj9A'I K Spf7 & G Sp -y 1`t� Phone Number: �S
Address: ?O �d x C�Tq y 1 k6 city: '7�.0 P-5. zip
Rev.10112
RIVERSIDE CTY/LE ON FACILITY
DEPT OF ENTAL HEALTH COUNTTY OF RIVERSIDE
3880 LEMON ST. #200 ;PARTMENT OF ENVIRONI`vIENTAL HEALTH
LAND USE APPLICATION
OFFICE USE ONLY
1 1/29/201 7 000001 verside•CA•92501-(951)955-8980 PE CODE: FEE:
#4421 2:4OPM KATIE0009 io•CA 922oI-pfio)863-757o 02-7ycel, N73 ,
722080 $464.00 7 lye LMSN APN: 't
772210 $9.28 USE OF PERMIT: �a
#2112 1 4e CA LL,"a
***TOTAL $473- 28
CHECK $473.28 Yl Inv uLw'1
CHANOE $D.DO 2335 �. 1nej4,ekjj9? cityer11 P22
21 Phone 15 _ 0 5- .29 rr_� Email 3
AGENT/ Company Name Agent/Contractor
CONTRACTOR: Mairing Addressi
Phone Email
Si nature Date i
PROPERTY INFO: Site Address 3 rcl en ber e )' Cit y-),er1 ,dye
W terA Mlell ��� D Lot Size cp L
SECTION B Below—For Office Use Only
CHECK BOX IF REQUIRED
If an box is checked,I—aoplication shall be considered denied until the information is provided.
G CeHolding Tank Agreements Required G Floor Plan and/or Plumbing Layout Racidred
rtificate of 6d5ling OWTS Required(CA2) C Special Feasibility Boring Report Required
G WOCB Clearance Required Detailed Contour Plot Plan Required(1 to 5 foot intervals)
Q Soils Percolation Re o rt Required
SITE E AL ATIO INSd CTION REI,
EHS INITIALS/DATE:
SECTION C
❑NEW I fi(REPAIR/REPLACEMENT ❑EXISTING ❑PUMP ❑ATU 1 ❑CONNECT TO SEWER I FIXTURE UNITS: BDRMS s
Soils Percolation/Boding Repon By: Oate: Project`-'
C 2Cerufication6y: f/ Date:OVA II /28�2f11� Licensed 458�1Li-7
Septic tank cap.: 4� oil Rate: Tested Depth: t Max. trench depth:
lobo ab P/X't`si
Sq.FL boMn Area: r otal Linear FL: Line(s): q
75 Ca•8 - J�d L'F J Length: 6(5 feet - Each 3 feet wide
Sidewall Allowance: FL Rock/ Sq.fL Running foot Rock below drain line: _in. or Xpiastic Chambers
Leach Lines'bed special design for slope: ❑WA n Overburden Factor:
Pit Diameter. No.pits: Depth below Inlet(bi): Pit Total Depth: Max.allowable depth:
ONSTRUCTIO AIMS
Ver, TIpN R
va- �I�Q ib kl �
� a
CT �
ihi a n
SECTION D '
This Application is Approved ❑Denied regarding the design of the OWTS as indicated on the accompanied plot plain using the requirements set forth in
Section C above.No constructlorilspermitted In the required reserved 100%Expansion area.
EHS Signature: Date: 11121 W
DEk SAM22 P.6Y.10114 ot=tLmn:'m.ffE-oacs Fe;YELLOW-exg Deµ PINK-Apph=